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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201142
Report Date: 02/22/2022
Date Signed: 02/22/2022 11:42:59 AM

Document Has Been Signed on 02/22/2022 11:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:EMMAUS HOMECARE INC.FACILITY NUMBER:
079201142
ADMINISTRATOR:BALMEO, MARCEL & QUENNIEFACILITY TYPE:
740
ADDRESS:3203 MUNRAS PLACETELEPHONE:
(650) 771-7909
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 6CENSUS: 0DATE:
02/22/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Quennie Balmeo, Licensee/AdministratorTIME COMPLETED:
11:55 AM
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On 2/22/2022 starting at 9:50 AM, Licensing Program Analysts (LPAs) L. Francisco and K. Nguyen arrived announced to conduct Pre-licensing Inspection. LPAs met with Licensee/Administrator, Quennie Balmeo and Marcel Balmeo. The facility is approved for all residents may be non-ambulatory.

LPAs toured facility including but not limited to 5 residents bedrooms, 3 bathrooms, 1 staff room, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside closet. There is sufficient lighting throughout facility. Room temperature was maintained at 71 degrees F and hot water temperature was maintained at 112.5 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 1/20/2022.

No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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